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The
area of concussions has become a mainstay in the media and medical
community for the past ten years. With the amount of professional
athletes retiring from this particular condition, more and more
emphasis is being placed upon prevention. Concussions have been
around for centuries, but were better known as ‘bell ringers’
before the 80’s. You would often hear the play-by-play announcer
on TV comment that a player was able to get up from the ice, “thank
god it was only his head, and not a career ending knee injury”.
It has only been the last twenty years that we have come to understand
what effect concussions will have upon a player’s future,
both on the ice and off.
A simplified definition of a concussion is when the brain is jarred
or knocked against the cranium (skull), resulting in swelling of
the brain. Anatomically, the brain will float in the cranium. This
can lead to more damage, as the brain does not therefore have a
nice protective rubber encasement to protect it from the hard outside
bone.
At Canadian Sports Therapy, our motto was “Prevention is the
Key to Success”, therefore the question is: How can we prevent
concussions? The obvious answer that everybody looks to first is
a proper fitting C.S.A. approved helmet. That is without a doubt
the most important feature, but the medical community has also recently
discovered another piece of equipment that may significantly reduce
this condition, the mouth guard.
Although the primary function of mouth guard is to prevent dental
injuries, a recent research study done by Notre Dame University
showed a dramatic reduction of concussions once mouth guards were
implemented for the football team in both practices and games. Dr.
Cosmo R. Castaldi, a dentist, worked extremely hard to make mouth
guards mandatory in Hockey in 1976, but it has unfortunately not
been strictly enforced.
Years ago I was medical director with a Junior A team where the
mouth guards were mandatory. Although we tried to strictly enforce
this rule, several players were without them or would chew black
gum and place it across the front of the teeth in case the referee
ever was to ask. Needless to say, black gum hasn’t yet been
proven to prevent concussions, but we are looking into it.
It has been proven that mouth guards can prevent dental injures,
but how do they reduce the likelihood of a concussion? During sporting
events, blows are continuously being given to the chin (jaw). When
a heavy blow is administered to the jaw from underneath, the force
will clang the teeth together and subsequently force the lower jaw
into the jaw joint (in front of ear). At this level, the forces
are transmitted to major nerves exiting the base of the brain, blood
supplies to the brain, as well as the balance centres located near
the jaw joint. The end result is leaving an athlete with a concussion,
with symptoms including dizziness, impaired speech, headaches, nausea
and earaches. The mouth guard will act as a cushion between the
teeth to absorb the forces from the blow. The guard will also separate
the lower jaw from the base of the skull, thereby reducing the collision
between the two bones.
If it has been proven that mouth guards can prevent so many injuries,
then why is it that so many players don’t like to wear them?
I put this question forth to Dr. Allan Hawryluk, former Toronto
Maple Leafs team dentist. He says, “Players won’t wear
them because they say they gag on them and have trouble breathing”.
In today’s modern medicine however, the new custom-made mouth
guards will prevent these two problems from happening. Dr. Hawryluk
states that he has offered every player a custom made mouth guard,
but not one has yet to take him up on the offer.
There are three types of mouth guards on the market today. The first
is the ‘Stock’. These are the kind you can find at any
sporting goods store, but are the least effective. They are a rigid
plastic, which are not form fitting to your mouth and can therefore
offer a false sense of protection. The second form of a mouth guard
is the ‘Boil and Bite’. This is often the most popular
one players will wear in minor hockey. They are made from a thermoplastic
material that once softened in hot water, will then form to the
teeth. Like the Stock mouth guards, they are also cheap, but uncomfortable
and can impair breathing and speech. The third form is the ‘Custom
Made’ mouth guard. Dr. Hawryluk states that a dentist will
take a plaster model of your teeth. Then a special shock absorbing
acrylic sheet is heated and vacuumed sealed to the model. It is
trimmed and will fit the athlete’s teeth perfectly. He states
it is so well fitting; they will sometime have trouble getting it
off the teeth following a game or practice. Players who wear them
declare that these guards will not prevent breathing difficulties
and if they were having gagging problems, they will not anymore.
The custom guards are “totally formed to your teeth in a very
specific way” says Dr. Hawryluk, “they are smaller and
therefore more comfortable”.
Mouth guards can vary in price, but when it comes to the possible
damage that may occur if not wearing one, money should not be an
issue. Dr. Hawryluk states that custom mouth guards will vary from
$80-$130, and that they may be covered by your extended health insurance
company.
Please visit your local dentist to get more information on custom
mouth guards and how to be fitted for one. Remember that you only
have one brain, so protect it any way you can.
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